Total mesorectal excision in MRI-defined low rectal cancer: multicentre study comparing oncological outcomes of robotic, laparoscopic and transanal total mesorectal excision in high-volume centres.

Autor:	Rutgers ML; Department of Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherlands., Burghgraef TA; Department of Surgery, Meander Medical Centre, Amersfoort, The Netherlands.; Department of Surgery, University Medical Centre, Groningen, The Netherlands., Hol JC; Department of Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherlands.; Department of Surgery, Hospital Gelderse Vallei, Ede, The Netherlands., Crolla RM; Department of Surgery, Amphia Hospital, Breda, The Netherlands., van Geloven NA; Department of Surgery, Tergooi Hospital, Hilversum, The Netherlands., Leijtens JW; Department of Surgery, Laurentius Hospital, Roermond, The Netherlands., Polat F; Department of Surgery, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands., Pronk A; Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands., Smits AB; Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands., Tuyman JB; Department of Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherlands., Verdaasdonk EG; Department of Surgery, Jeroen Bosch Hospital, Den Bosch, The Netherlands., Sietses C; Department of Surgery, Hospital Gelderse Vallei, Ede, The Netherlands., Consten EC; Department of Surgery, Meander Medical Centre, Amersfoort, The Netherlands.; Department of Surgery, University Medical Centre, Groningen, The Netherlands., Hompes R; Department of Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherlands.
Jazyk:	angličtina
Zdroj:	BJS open [BJS Open] 2024 May 08; Vol. 8 (3).
DOI:	10.1093/bjsopen/zrae029
Abstrakt:	Background: The routine use of MRI in rectal cancer treatment allows the use of a strict definition for low rectal cancer. This study aimed to compare minimally invasive total mesorectal excision in MRI-defined low rectal cancer in expert laparoscopic, transanal and robotic high-volume centres. Methods: All MRI-defined low rectal cancer operated on between 2015 and 2017 in 11 Dutch centres were included. Primary outcomes were: R1 rate, total mesorectal excision quality and 3-year local recurrence and survivals (overall and disease free). Secondary outcomes included conversion rate, complications and whether there was a perioperative change in the preoperative treatment plan. Results: Of 1071 eligible rectal cancers, 633 patients with low rectal cancer were identified. Quality of the total mesorectal excision specimen (P = 0.337), R1 rate (P = 0.107), conversion (P = 0.344), anastomotic leakage rate (P = 0.942), local recurrence (P = 0.809), overall survival (P = 0.436) and disease-free survival (P = 0.347) were comparable among the centres. The laparoscopic centre group had the highest rate of perioperative change in the preoperative treatment plan (10.4%), compared with robotic expert centres (5.2%) and transanal centres (2.1%), P = 0.004. The main reason for this change was stapling difficulty (43%), followed by low tumour location (29%). Multivariable analysis showed that laparoscopic surgery was the only independent risk factor for a change in the preoperative planned procedure, P = 0.024. Conclusion: Centres with expertise in all three minimally invasive total mesorectal excision techniques can achieve good oncological resection in the treatment of MRI-defined low rectal cancer. However, compared with robotic expert centres and transanal centres, patients treated in laparoscopic centres have an increased risk of a change in the preoperative intended procedure due to technical limitations. (© The Author(s) 2024. Published by Oxford University Press on behalf of BJS Foundation Ltd.)
Databáze:	MEDLINE
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